Exercise is Medicine

Linking Clinical to Community

The EIM solution describes an approach to activating Exercise is Medicine^® through partnerships between local health care systems/medical practices and community fitness resources, building a “bridge of trust” for coordinated care.

Patients are more likely to be referred for exercise guidance and to engage in recommended levels of physical activity when health care systems and community fitness enterprises work together, developing smooth referral and communication pathways. The goal is to implement physical activity interventions that will slow, stop and reverse the progression of chronic diseases.

The adoption of Population Health Management strategies by health care stakeholders has created a significant opportunity for physical activity to be established as a standard in health care. Population health seeks to identify and invite groups of patients with similar diagnoses or medical challenges to participate in a healthy lifestyle or physical activity intervention. The objective is to improve health outcomes, cost-effecitveness and care coordination. Changing reimbursement models (the transition from volume-based to value-based care) and the consolidation of health systems will accelerate the adoption of this model.

An EIM solution requires the commitment of collaborating health care and community leaders and champions and is achieved by:

Assessing physical activity levels of each patient at every clinic visit. The most effective way to accomplish this is to embed a “Physical Activity Vital Sign (PAVS)” into electronic health records (EHRs).
Providing patients with brief advice about physical activity and/or an exercise “prescription” tailored for their specific medical conditions.
Referring patients to appropriate physical activity resources, such as an evidence-based physical activity program led by qualified professionals. (Some patients may benefit from physical therapy or cardiac rehabilitation programs before being referred to a generalized exercise program.)

EIM Greenville is a multidisciplinary team of stakeholders from a local health system, university, medical school and YMCA in Greenville, South Carolina that has successfully implemented an EIM solution. EIM Greenville has developed a comprehensive toolkit and offers consulting services that can be purchased by interested health care systems and community partners. Contact eim@acsm.org for purchasing details.

Three different domains are essential in bringing about the vision of EIM:

1. Health Care Systems and Providers. Health care providers include physicians, nurse practitioners, physician assistants, nurses, physical therapists and others working together to provide optimal care and disease prevention. With the assistance of tools embedded in the EHR, providers can more easily integrate physical activity assessment and promotion into routine clinical care. Other members of the health care team play a critical role in creating a smooth workflow for EIM, including physician extenders, medical assistants and front desk staff. See EIM resources for clinicians.

2. Physical Activity Resources: Places, Programs and Professionals. Community partners can serve as an extension of the health care team through qualified exercise professionals and evidence-based programs.

EIM Places should be conveniently located for patient access. They employ qualified fitness staff, provide safe and effective physical activity programs/services, and meet facility safety standards.
EIM Programs should be customized according to participants’ specific chronic disease(s), risk levels, physical and motivational readiness and personal preferences. Evidence-based interventions may include:
- Small group-based exercise and lifestyle modification programs
- Individually guided exercise training and behavioral support
- Self-directed programs
Exercise Professionals with the EIM Credential and/or clinical certifications (from NCCA or ISO/IEC 17024 accredited organizations like ACSM), can provide referred clients with tailored exercise, education and behavior modification guidance. See EIM resources for exercise professionals.
- The EIM Credential is a designation signifying competence in the area of exercise prescription for patients who have chronic diseases and other co-morbidities.

3. Digital Health Technology. Health care systems have a wide spectrum of technologies that can be used to accelerate the successful integration of healthy lifestyle interventions. These technologies allow for integration of the physical activity vital sign and referral pathways, identification of patients who would benefit from lifestyle interventions, and tracking patient data. Examples include:

Electronic health record (EHR) systems
Population health management (PHM) applications
Patient-centered medical home (PCMH) applications
Health information exchanges (HIE)

On the community/fitness side, there has been an explosion in technology platforms, devices, and applications to facilitate activity tracking, promote participant engagement and monitor outcomes.

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Gold level recognition is the highest level of recognition and signifies the implementation of one or several components of the EIM Solution on the University campus, with the potential of extending into the local community. Community partnerships provide real world experience for students, while providing service to the local community.

Gold level campuses must assess physical activity as a vital sign.

A Gold level campus must also be engaged in at least (1) of the following:

* My campus assesses their patients' physical activity as a vital sign?

Yes No

* My campus is creating collaborations between university health care professionals and exercise professionals to provide physical activity prescriptions?

Yes No

* My campus has non-clinical professionals/departments directing students, faculty, and/or staff to the recreation center for health and fitness counseling?

Yes No

* My campus has a computer-based system to track patient participation in physical activity interventions?

Yes No

Other:

Silver level recognition includes activities related to awareness and promotion, and incorporates education for the university’s students, faculty, staff, and health care professionals, as well as those in the surrounding community, on EIM and its mission on campus. Silver campuses are actively engaged in educating others on the EIM solution for both the treatment and prevention of long-term illness and disease. University students are educated on the aims of EIM in health care, potentially certified as EIM health fitness professionals, and guided on how they can play a role in making physical activity an integral part of health care.

Silver level campuses must be engaged in at least (3) of the following: * My campus hosts classes that teach students the fundamentals of EIM on Campus and their potential role in fulfilling the mission of EIM?

Yes No

* My campus trains students to educate campus community members on EIM and the importance of physical activity as medicine?

Yes No

* My campus works with campus health services so that every health care provider discusses physical activity with every patient or client?

Yes No

Other:

Bronze level recognition is the first step in creating the EIM initiative on Campus. These campuses bring attention to the growing need for physical activity and take action in helping to create a healthier, more active campus environment.

Bronze level campuses create awareness of the importance of exercise and regular physical activity for health and promote exercise to students, faculty, staff and the community through engagement in any of the following activities. Bronze level campuses must engage in at least (3) of the following:

* My campus hosts events that promote physical activity?

Yes No

* My campus markets events that encourage all campus members to discuss physical activity with their health care professional?

Yes No

* My campus has created options for exercise that are easily accessible to the campus community?

Yes No

* My campus has completed a Mayoral, Governor, or University President EIM on Campus Month Proclamation?

Yes No

Other:

* Contact Person/Program Director:

* Resource Type (check all that apply):
Clinic or Hospital (inpatient) Community
Clinic or Hospital (outpatient) Home Based
Cancer Exercise Professional Digital/Online
Research Study

* What age groups are included (check all that apply)?
Adult Pediatric

* What cancer types are included in your program?

* What stages of treatment are included (check all that apply)?
Curative    Palliative
During Treatment    Post Treatment
Rehabilitation    Prehabilitation

* Who refers into the program? (How do clients access your program?) (check all that apply)
Client Clinician
Other

* What are the qualifications of the instructors?

* Is there a baseline safety evaluation of the client?

* If yes, performed by whom (check all that apply)?
Instructor Physician
Other

* What is the program duration? (e.g.; 12 weeks, 1 year)

* What is the frequency of sessions per week?

* Are sessions conducted in groups or individualized (check all that apply)?
Group Individualized

* How many years has the program been running?

* How many clients go through your program per year?

* Has your program ever been evaluated or audited?

* Please include a brief description (250 words or less) summarizing the above information:

* Who filled out this form?

* What is your role in the program?

An EIM solution requires the commitment of collaborating health care and community leaders and champions and is achieved by:

Assessing physical activity levels of each patient at every clinic visit. The most effective way to accomplish this is to embed a “Physical Activity Vital Sign (PAVS)” into electronic health records (EHRs).
Providing patients with brief advice about physical activity and/or an exercise “prescription” tailored for their specific medical conditions.
Referring patients to appropriate physical activity resources, such as an evidence-based physical activity program led by qualified professionals. (Some patients may benefit from physical therapy or cardiac rehabilitation programs before being referred to a generalized exercise program.)

Three different domains are essential in bringing about the vision of EIM:

EIM Places should be conveniently located for patient access. They employ qualified fitness staff, provide safe and effective physical activity programs/services, and meet facility safety standards.
EIM Programs should be customized according to participants’ specific chronic disease(s), risk levels, physical and motivational readiness and personal preferences. Evidence-based interventions may include:
- Small group-based exercise and lifestyle modification programs
- Individually guided exercise training and behavioral support
- Self-directed programs
Exercise Professionals with the EIM Credential and/or clinical certifications (from NCCA or ISO/IEC 17024 accredited organizations like ACSM), can provide referred clients with tailored exercise, education and behavior modification guidance. See EIM resources for exercise professionals.
- The EIM Credential is a designation signifying competence in the area of exercise prescription for patients who have chronic diseases and other co-morbidities.

Electronic health record (EHR) systems
Population health management (PHM) applications
Patient-centered medical home (PCMH) applications
Health information exchanges (HIE)

On the community/fitness side, there has been an explosion in technology platforms, devices, and applications to facilitate activity tracking, promote participant engagement and monitor outcomes.

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What is the EIM solution?

Linking Clinical to Community

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